The Foundation for Surviving with Pancreatic Cancer (SOAK), and the resulting “Support Casper” campaign, has sponsored dozens of researchers seeking better treatments for pancreatic cancer in its 10 years of existence. Now they are also supporting an initiative to get the “disappeared” drug phenformin back into production and tested for effectiveness. Foundation secretary-treasurer Rein Vehmeijer talks about it.

‘Pancreatic cancer is the second deadliest form of cancer. Every year, over 3,000 patients in the Netherlands are diagnosed and about the same number die from it. Our goal is to improve that survival,’ says Vehmeijer. ‘When we started in 2015, we knew very well that we would not reach our goal in a few years, but that it would certainly take until 2030.’ The foundation was founded by people with direct involvement with (patients with) pancreatic cancer. It started as an initiative to support Rotterdam oncological surgeon Prof Casper van Eijck. In a short time, Support Casper had raised €300,000 with which a PhD student could start work. Encouraged by this success, the initiators decided to professionalise the organisation. Through various fundraising actions, they succeeded in raising solid amounts of money (the counter now stands above 25 million) to finance research into innovative strategies for the treatment of pancreatic cancer. Two lines of research took centre stage: immunotherapy and treatment with oncolytic viruses. A growing stream of publications shows that the researchers are making good progress and are on their way to clinical applications. ‘Our Foundation also has the role of booster in this. Universities are obviously mainly focused on research, our interest is that the treatment gets to the patient as soon as possible.’

Old diabetes drug
In 2024, Support Casper became involved in a third approach to pancreatic cancer: treatment with phenformin, a project by Prof Hanneke Wilmink (Amsterdam UMC), Prof Casper van Eijck (Erasmus MC) and Dr Remco Molenaar (Amsterdam UMC). ‘Phenformin was used to treat diabetes until the 1970s,’ says Vehmeijer. ‘It was then withdrawn from the market because of serious side effects. But there was evidence even then that phenformin could be effective against several cancers, including pancreatic cancer. And the advantage of such an existing drug is that a lot is already known about it, so you can bring it to the market much faster than a new treatment.’

Phenformin is closely related to metformin, the first-line treatment for type 2 diabetes. Recent studies with metformin show that this drug can kill cancer cells by affecting cell metabolism. Phenformin is many times more active than metformin and penetrates the cell more easily. It is therefore a promising option that deserves further investigation. The relatively rare serious side effect (metabolic acidosis) may be well monitored and be a more acceptable risk in the treatment of a deadly form of cancer than in the daily treatment of a chronic disease like diabetes.

‘The problem was that phenformin was no longer produced anywhere,’ says Vehmeijer. ‘So to conduct clinical trials, we had to start production to begin with.’ Together with the FAST hub RARE-NL and the company Orfenix BV, both specialised in drug repurposing, Support Casper first set to work to draw up a business plan. ‘Now, together, we have almost everything in place for setting up a company. From Support Casper we are supporting that with a new investment fund, the Support Casper Social Impact Fund,’ says Vehmeijer. ‘We are already investing in the production of phenformin, so that if all goes well, phase 1 and phase 2 studies can start in 2026.’ That production (under GMP conditions, of course) is in the hands of a Dutch company, which can easily scale up if necessary.

Socially responsible and transparent
“To give this drug a chance, do good research and then also have production and distribution in good order, you have to take a business-like approach,” says Vehmeijer. ‘But that does not mean you have to pursue profit optimisation. Those who are now setting up this company with us all have the principles of socially responsible drug development at heart. We call it “Fair Medicine” on our website, the holdings of Amsterdam UMC and Erasmus MC and RARE-NL speak of socially responsible valorisation, but it essentially boils down to the same thing. We all want the drug to reach the market as widely and quickly as possible at the lowest possible price. And that means that we can also lay down those principles in the BV we set up together and be maximally transparent to our supporters about how our funds are spent.’ The latter is of special importance to Vehmeijer because SOAK’s funds come from donors and he feels it is important not to betray their trust.

Vehmeijer therefore prefers to work with parties that also have social objectives and for whom profit is not paramount. ‘Fortunately, there are more and more investors who attach less value to the economic return on investment and mainly want to do socially good things. The fact that we founded this company with two universities and two foundations and managed to attract additional funding from third parties is unique. Support Casper certainly plans for the coming years to make more affordable treatments available to patients with pancreatic cancer’.

Drug Repurposing Venture Challenge
Drugs that are (have been) already on the market, such as phenformin, can sometimes, for new indications, be a way to have an effective treatment quickly and affordably. Drug repurposing is therefore one of the pillars of FAST, including through the hub RARE-NL. To raise awareness of drug repurposing and stimulate the business potential of socially responsible repurposing, ZonMw and FAST are organising the Drug Repurposing Venture Challenge this summer. It is a competition, in which participants also work in bootcamps to develop their business plan. This year’s winning team will be announced on 8 October. For more information visit the webpage.